Age Safe® Services Membership

Your Complete Name

Your Title

Your Business Name

Business Address, City, State/Province, Zip

Mailing Address, City, State/Province, Zip

Business Phone

Mobile/Cell Phone

Contact e-mail Address

Business Website Address

Occupation/Category

---Accounting ServiceAdult Day CareAssisted LivingAttorneyCarpet CleanersComputer Service & RepairContractor/RemodelerCrime PreventionCustom JewelerDaily Money ManagerDental ServicesDownsizing/DeclutterElder LawElectrical ContractorEstate ServicesFiduciary/Advocate/ GuardianFinancial AdvisorFinancial ServicesFuneral Pre-Planning/TrustGeriatric Care ManagerHandyman ServicesHome Care ServicesHome Health CareHome InspectorHome MaintenanceHome ModificationsHome Safety AdvisorHome SecurityHVAC Installation & RepairInsuranceInterior DesignLandscapingLife Care ConsultantLocksmithMaid/Cleaning ServiceMobility/AccessibilityMoving/StorageNatural Health ProviderOccupational TherapyPest Control ServicePet SittersPhysical TherapyPlumberProfessional OrganizerReal Estate AgentReverse Mortgage ProviderRoofing ContractorSenior Living AdvisorSenior Move ManagerSmart Home TechnologyOTHER

Relationship of Parties:

Age Safe America, LLC ("ASA") and the applicant or ("MEMBER") do not intend by this Agreement to create the relationship of partners, joint ventures, principal-agent, or employer‐employee. The Member is engaging Age Safe America for the specific purpose of becoming a Member and/or inclusion in the Services Registry and aligning with our mission and vision.

Use of Member Information

The information gathered throughout the process of the membership application is intended for the review of the ASA staff and/or Board of Directors. Certain parts of the application are intended to be shared publicly. Generally speaking, shared information includes marketing-type content such as: company name, provided services, location, and contact data. You hereby grant Age Safe America, LLC ("ASA"), and/or its authorized agents, the rights to use the information herein, as defined above, for informational, publicity, or promotional purposes.

We use the information you provide about yourself when applying for membership to process that application, and only share this information with outside parties to the extent necessary to process that application, including to a background screening company.

We request email addresses to set up user accounts for applying for membership. The email address is used for the application and as a point of contact for applying, and for communicating with you regarding your application. We will use your email address for issuing periodic newspapers, provide useful information on training courses, membership, and the registry, and to contact you regarding referrals received from our site. Your email address is not shared with outside parties.

Finally, we never use or share the personally identifiable information provided to us online in ways unrelated to the ones described above without also providing you an opportunity to opt-out or otherwise prohibit such unrelated uses.

Use of Member Logo

Age Safe America, LLC hereby grants to MEMBER a limited, non-exclusive, non-transferable, revocable right to use the Age Safe® America/Age Safe® Canada “Proud Member” logo ("Mark") in their marketing and advertising efforts. The logos are the property of Age Safe America, LLC (“ASA”) but may be used by a MEMBER in Good Standing in accordance with the terms and conditions set forth below in section titled (Members in Good Standing Agree to). Use of the MARK shall constitute consideration for, agreement to, and acceptance of the following terms and conditions by the MEMBER:

The logo MARK is the sole and exclusive property of ASA. These logos may be used only by ASA Members in Good Standing if and only if such use is made pursuant to the terms and conditions of this limited and revocable license. Any failure by a member to comply with the terms and conditions contained herein may result in the immediate revocation of this license, in addition to any other sanctions imposed by ASA or other legal liability. The compliance and enforcement (or lack thereof) of these terms and conditions shall be made by ASA in its sole discretion.

The logos may not be revised or altered in any way, and must be displayed in the same form as produced by ASA. The logos are each four colors; inside a blue rectangle box. The official colors of the Age Safe® America logos are Red, White, Blue and Gray. The official colors of the Age Safe® Canada logo is Red, White, Gray and Gold. The logos must be printed in their official colors or in black and white. The logos may never be used independent of the term "PROUD MEMBER", within the graphic logo.

The logos may be used in a professional manner on the Member's business cards, stationery, literature, advertisements, storefront window, Web site, social sites or in any other comparable manner to signify the user's membership in ASA. Logo may NOT be used on clothing, uniforms or hats, etc. Logo size cannot exceed 5" X 5" for ANY usage.

Notwithstanding the foregoing, the logos may not be used in any manner that, in the sole discretion of ASA: discredits ASA or tarnishes its reputation and goodwill; is false or misleading; violates the rights of others; violates any law, regulation or other public policy; or mischaracterizes the relationship between ASA and the MEMBER, including but not limited to any use of the logos that might be construed as an endorsement, approval, sponsorship, or certification by ASA of the user, the user's business or organization, or the user's products or services, or that might be reasonably construed as support or encouragement to purchase or utilize the user's products or services.

Use of the logos shall create no rights for users in or to the logos or their use beyond the terms and conditions of this limited and revocable license. The logos shall remain at all times the sole and exclusive intellectual property of ASA. ASA shall have the right, from time to time, to request samples of use of the logos from which it may determine compliance with these terms and conditions. Without further notice, ASA reserves the right to prohibit use of the logos if it determines, in its sole discretion, that a Member’s logo usage, whether willful or negligent, is not in strict accordance with the terms and conditions of this license, otherwise could discredit ASA or tarnish its reputation and goodwill, or the user is not an ASA Member in Good Standing.

Age Safe®, Age Safe® America, Age Safe® Canada, Senior Home Safety Specialist®, Advancing Successful Aging at Home®, Aging in Place Essentials™, Age Safe® Live Well, Age Safe® in Place, Age Safe® Assessment, Age Safe® APPROVED and Age Safe® at Home are either USPTO/CIPO Registered Trademarks, Pending USPTO/CIPO Registered Trademarks or Trade Names all belonging to Age Safe America, LLC.

A MEMBER will not use ASA's trade names or abbreviation in their Corporate title, tradename, and/or Business name or in any way that might result in confusion as to separate and distinct identities of Age Safe America, LLC and MEMBER. MEMBER recognizes and acknowledges ASA ownership and title to the Marks. MEMBER further agrees not to contest or take any action in opposition to any trademark, service mark, trade name or logo of ASA or to use, employ or attempt to register any mark or trade name which is similar to any mark or trade name of ASA.

Remember, you cannot use the trademarked words Senior Home Safety Specialist®, SHSS, Age Safe®, Age Safe® America, or any other Registered or Pending Trademarks or Trade Names belonging to Age Safe America, LLC; in your business name, corporate name, website address (domains) or email address.

This license is for the use of the Age Safe® America/Age Safe® Canada “Proud Member” logo only. Use of any other ASA trademark requires a separate license, which may require additional conditions, such as educational requirements.

Privacy of Information:

Your information is governed by, and you agree to, our Privacy Policy, found here: https://agesafeamerica.com/privacy-policy/.

Term and Termination:

This Agreement shall be effective as of the date signed and shall remain in full force for one year. On each anniversary of that date thereafter, the Term shall be extended for an additional year, unless it is terminated by action of ASA or the MEMBER for violation of these terms or non-payment of the annual renewal fees or compliance with the requirements of a member in Good Standing.

In the event a MEMBER violates any applicable laws, regulations or generally accepted ASA guidelines or engages in conduct that is malicious, deceptive, misleading, fraudulent or illegal, including but not limited to inactivity or breach of any requirements of this Agreement, ASA reserves the right, at its option and sole discretion to terminate this agreement.

Governing Law

This Membership Agreement shall be governed by the laws of the state of Florida, USA. The parties agree to irrevocably submits to the personal jurisdiction and venue of courts of Sarasota County, Florida for purposes of any claim, action, suit or other proceeding arising out of or relating to this Agreement or the breach hereof, or for issues implication Federal law, the U.S. District Court for the Middle District of Florida, Tampa Division. Each party hereby waives and agrees not to assert as a defense or otherwise, any claim that is not subject to the jurisdiction of such courts, that the claim, action, suit or other proceeding is brought in an inconvenient forum or that venue is improper, or that this Agreement may not be enforced in or by such courts.

Annual Membership Fee

$199.00 (includes Background Check fee)*

Members in Good Standing Agree to

• Pass a background check performed by our US based partner.

• Require background checks on employees working with seniors in the home.

• Adhere to our Code of Conduct and Fair Practice

• Remain current on their annual membership fees.

Payment of Membership Fee is in no way a guarantee that you will be accepted as a Member. If you are NOT accepted as a Member, the Membership Fee will be refunded in full less the background check fee of $50.00.

Note

The background check company will want a picture of your drivers license to confirm the spelling of your name. Please use your smart phone, digital camera or color scanner. (NO PHOTOCOPY)

*Some counties may have additional access fees, which will be billed to you separately from Reliable Background Screening.

Applicant Verification

I certify that the information provided herein is accurate and complete. I or the business that I represent further agree that all disputes and claims, individual or severable, involving this Membership will be submitted to the Age Safe America Directors for final resolution, and their decision is binding and cannot be appealed. By typing your name below you are signing this document and representing that you have read and understand this Membership Application Agreement.

I affirm that I have reviewed the above information and agree to abide by its terms.

Full Name Signature